Prospective Rct, Comparative Study Of Bent Ab Interno Needle Goniectomy Versus Conservative Treatment For Evaluation Of Intraocular Pressure, Anti Glaucoma Medication And Quality Of Life Poag Patients

To find efficacy of BANG versus Conservative Treatment  for lowering IOP, Antiglaucoma Medicationa and improving Quality of Life in POAG patients  

Advanced Eye Centre, PGIMER, Chandigarh, India a tertiary referral centre

46 patients were recruited prospectively from glaucoma clinic of a tertiary institute and randomized in two groups- Group A: BANG (N=23) and Group B: Conservative management (N=23). Group A underwent BANG and Group B managed conservatively. Patients were evaluated for IOP control, number of AGMs and QOL as primary outcome and VA, VF, Endothelial cell density, CCT and complications as secondary outcome at baseline and follow up visits at  1and7 days,  1 , 3 and 6 months.  For IOP, success was defined as IOP <21 mmHg or at least 20% reduction from baseline.

 Baseline characteristics were comparable between two groups. IOP was less than 21 mmHg in all patients- 18 without medication and 5 on 1 or 2 medication in Group A. IOP reduction change was significant at 6 month FU. In Group B, IOP change was not significant. Comparing two groups, there was a significant change in IOP at final FU. AGMs decreased by 91.7% in Group A and increased by 34.1% in group B at final FU. QOL improved in Group A and deteriorated  in group B significantly and  comparing QOL in two groups was  also significant. Comparing two groups for VA, VF, CCT  at 6 M  showed significant change . Most of complication in group A were mild and transient except iris atrophy persisted in one patient .

Standalone BANG is a cost effective procedure suitable for developing countries. IOP decreased by 19.4% and  AGMs decreased by  88.84 % at 6 months. BANG can be an alternative to costly MIGS. Quality of life also improved in BANG group.